THE MANAGEMENT OF MASSIVE LOWER GASTROINTESTINAL-BLEEDING

To evaluate what has been the most effective surgical treatment for ma ssive lower gastrointestinal bleeding, we reviewed the records of 31 p atients who underwent colon resection for hemodynamic instability and/ or the need for continued transfusions. These 31 patients underwent ei ther segmental colectomy (21 patients) or subtotal colectomy (10 patie nts). Resections were performed for diverticular disease (19 patients) , angiodysplasia (eight patients), acute ulceration (three patients), and polyps (one patient). The re-bleeding rate (mean follow-up 1 year) for subtotal colectomy was 0 per cent, segmental resection with posit ive angiography was 14 per cent, and segmental resection with negative angiography was 42 per cent. The complication rate including myocardi al infarction, ARDS, pneumonia, and renal failure was highest (83 per cent) in those patients receiving segmental resection with a negative angiogram. The mortality rate was also highest for segmental resection patients with negative angiography (57 per cent). The results of this review suggest that segmental resection should be performed when the bleeding site is identified angiographically. Subtotal colectomy shoul d be reserved for massive bleeding with negative angiography.